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PubMed2006

A pain management program for chronic cancer-treatment-related pain: a preliminary study.

UNLABELLED: A large proportion of patients may develop chronic pain following cancer treatments such as surgery, radiotherapy, or chemotherapy. These patients can experience significant levels of physical and psychological morbidity. Our aim was to investigate a cognitive-behavioral pain management program (PMP) for cancer patients with chronic treatment-related pain. Thirteen patients (1 man, 12 women; mean age 52 yrs) completed the study, 9 of whom had a history of breast cancer and had received extensive medical treatment, including surgery. A combination of physical and psychological techniques were adapted from previous work in chronic benign pain and implemented by two therapists. Interventions included education, relaxation, exercise training, and goal setting. A variety of outcomes were examined to assess general fitness, psychological distress, coping success, activities of daily living, and pain report. The median number of interventions by each therapist was 10 (4 to 15). Postintervention, there was a significant trend toward improvement in many variables, including anxiety and depression (P < .01), fitness (walking: P < .05), and coping with pain (P < .01). This was a feasibility study and has several limitations. It appears, however, that all patients had a positive outcome. Further research is now required to assess the effectiveness of this approach. PERSPECTIVE: Results of this preliminary study are clinically relevant, as they suggest that a pain management program that uses cognitive-behavioral principles is worthy of further investigation for patients with chronic cancer-treatment-related pain.

Adult↗
PubMed1989

A conceptual framework and methodological criteria for family therapy process research.

This article presents a conceptual framework for family therapy process research that integrates a new process perspective with family systems theory. Consistent with a systemic epistemology, the framework focuses on the circular interaction, over time, between and within the therapist and family systems and their subsystems. Attacking the process--outcome distinction, the framework targets key variables and patterns in change processes that occur within and outside of sessions. The empirical implications of each framework component are explored. The article concludes with three methodological criteria for developing and evaluating certain research instruments to be used in process studies within the new conceptual framework.

Family↗
PubMed1994

Critical appraisal of research literature by expert and inexperienced physical therapy researchers.

BACKGROUND AND PURPOSE: In this study, critical appraisal skills of physical therapists who were inexperienced and expert researchers were compared and the effect of the following independent variables on the appraisal skills of novices was examined: years of physical therapy practice, postgraduate experience with research, level of comfort with research, journal reading habits, and content-specific expertise. SUBJECTS AND METHODS: Four expert and 20 inexperienced researchers critiqued the same research article. A content analysis of the expert critiques was used to develop a set of 12 items of concerns about the study. RESULTS: Experts identified a mean of 7.75 items of concern; novices identified a mean of 3.95 items. For 10 of the 12 items, a greater proportion of experts identified each concern compared with the novices. Novices had comparatively less difficulty identifying concerns with internal validity than they did identifying issues relating to construct validity. Only one of the variables--content-specific expertise--was associated with differences in critical appraisal skills among the novices. CONCLUSION AND DISCUSSION: These finding suggest that analysis of construct issues in research articles is a more advanced skill than analysis of research design and that critical appraisal of research literature is enhanced by clinical experiences related to the subject of the research report.

Physical Therapy Modalities↗
PubMed1981

Engaging "resistant" families in treatment.

Many families, when presented with the option of family therapy, are less than eager to participate. This paper comprises the second and third parts of a series on engaging "resistant" families. Part II presents 21 principles and a number of techniques and strategies that have been developed for successfully recruiting such families. These techniques should be applicable for engaging resistant families with all types of presenting problems. Part III provides an analysis of the important variables involved, along with data on cost efficiency and administrative costs. It was found that when therapists had administrative control of their cases, serving in dual roles as both therapists and drug counselors, the recruitment effort was (a) more effective (i.e., complete families, including both parents or parent surrogates, were recruited in 77 per cent of the cases), and (b) twice as cost efficient. Two-thirds of the non-engaged families were not recruited because the index patient would not allow family members to be contacted. Black families were more difficult to recruit than whites. Data on cost efficiency and on the actual administrative costs of recruiting families are also provided.

Adult↗
PubMedDate not supplied

Optimization of temperature distributions in scanned, focused ultrasound hyperthermia.

Scanned, focused ultrasound systems (SFUS) have considerable flexibility in shaping the power deposition field during hyperthermia treatments. When utilizing this adaptability many complicated, interacting decisions must be made to obtain an optimal steady-state temperature distribution. This optimization problem is studied using a 3-D, radially symmetric simulation program which searches for a set of optimal scan parameters. The conjugate-gradient optimization technique with a golden section search was used to obtain the optimal temperature distributions attainable with a single circular scan of a tumour. The variable scan parameters of the single transducer heating system optimized (and under the control of the therapist) are: transducer tilt and rotation angles, focal depth, output acoustical power, and scan radius. This single scan study includes the effects of tumour and normal tissue blood perfusions, tumour depth, skin temperature boundary condition, as well as tumour size and shape. A similar, but less comprehensive, study was done for larger tumours using two concentric circular scans. The results show that (1) the optimization process can produce a set of scan parameters that give a considerably better temperature distribution than could be obtained ad hoc, and (2) the optimal scan parameter configuration obtained produces a close-to-ideal tumour temperature distribution for a wide variety of clinically relevant conditions. Thus, when extended to include data from individual patients such optimization should be a very useful tool in patient treatment planning, and should enhance the present capabilities of clinical scanned, focused ultrasound systems.

Body Temperature↗
PubMedDate not supplied

Factors influencing entry-level occupational therapists' attitudes toward persons with disabilities.

Negative attitudes exhibited by rehabilitation professionals could have adverse consequences for persons with disabilities in their achievement of desired outcomes. Because occupational therapists are in a position to exert considerable influence in the therapeutic relationship, this study explored entry-level occupational therapy practitioners' equal status contact with and attitudes toward persons with disabilities. METHOD. Questionnaires were sent to 402 entry-level occupational therapists. These questionnaires consisted of: a demographic scale, the Disability Social Distance Scale, the Contact With Disabled Persons Scale, and a Similarity Scale (constructed for this study to evaluate the concept of equal status). Data analysis explored the relationship between 172 respondents' equal status perception and contact with persons with disabilities and their attitudes toward persons with disabilities. RESULTS. Respondents exhibited generally positive attitudes toward persons with disabilities. Perceived equality, personal and professional contact, and the majority of demographic factors were not significantly correlated with their attitudes toward persons with disabilities. Respondents who specified working with persons without disabilities in the wellness capacity exhibited more positive attitudes than those working with persons with biomechanical and neurological disabilities. In addition, respondents who had a greater frequency of professional contact with persons with disabilities also appeared to experience more personal contact with persons with disabilities. CONCLUSION. Entry-level occupational therapists' attitudes toward persons with disabilities may not only be influenced by parameters of the contact variable but also by the profession's holistic philosophy, the occupational therapy educational curricula, and the personal characteristics of those who choose to pursue a career in occupational therapy.

Adolescent↗
PubMed2000

Demographic, clinical, and neurocognitive correlates of everyday functional impairment in severe mental illness.

Although cognitive deficits often accompany severe mental illness, their implications for everyday functioning remain poorly understood. In this study, an occupational therapist (OT) rated the everyday functioning of 105 adult psychiatric patients. Using demographic, clinical, and cognitive variables, the authors tested alternative models to account for the observed variability in OT ratings. Although age, education, and the presence of schizophrenia each contributed to a model that accounted for 27% of the variation in functional independence, adding terms for auditory divided attention and verbal learning increased the proportion of explained variance to 45% and decreased the beta weights for age and education--but not schizophrenia--to nonsignificant levels. These findings demonstrate the relevance of cognitive performance to everyday functioning in severe mental illness. They are discussed with respect to hypothesized determinants of psychiatric disability.

Activities of Daily Living↗
PubMed2000

[Clinical spectrum and management of holoprosencephaly].

To study the phenotypic spectrum and management of holoprosencephaly (HPE), we reviewed the findings of eight children with HPE from 3 to 10 years of age, who underwent intervention programs and rehabilitation at our center. One patient had alobar HPE, three semilobar HPE, and four lobar HPE. All patients had postnatal growth retardation, and seven showed a decreased BMI (< 25% tile). All patients had severe developmental delay and mental retardation (DQ < 40), showing no obvious correlation between their severity and the type of HPE. Neurologically seven patients had spasticity (3 spastic quadriplegia, 2 spastic diplegia, 2 mixed-type), except one patient with a 7q deletion [46,XY,del(7) (q35)] who had generalized hypotonia. Seven had variable types of seizures. All patients had feeding difficulties and were assessed by speech-language therapists. Four patients required tube feeding, four had gastroesophageal reflux disease. Recurrent respiratory tract infection was common. Three patients had abnormal serum sodium concentration (1 diabetes insipidus, 1 idiopathic hypernatremia, 1 hyponatremia). No family history of HPE was elicited. In conclusion, patients with HPE should be followed up closely for complications such as feeding difficulty, malnutrition, seizures, spasticity, infection, and osmoreceptor-hypothalamus-hypophyseal axis abnormalities.

Child↗
PubMed2006

When to use agreement versus reliability measures.

BACKGROUND: Reproducibility concerns the degree to which repeated measurements provide similar results. Agreement parameters assess how close the results of the repeated measurements are, by estimating the measurement error in repeated measurements. Reliability parameters assess whether study objects, often persons, can be distinguished from each other, despite measurement errors. In that case, the measurement error is related to the variability between persons. Consequently, reliability parameters are highly dependent on the heterogeneity of the study sample, while the agreement parameters, based on measurement error, are more a pure characteristic of the measurement instrument. METHODS AND RESULTS: Using an example of an interrater study, in which different physical therapists measure the range of motion of the arm in patients with shoulder complaints, the differences and relationships between reliability and agreement parameters for continuous variables are illustrated. CONCLUSION: If the research question concerns the distinction of persons, reliability parameters are the most appropriate. But if the aim is to measure change in health status, which is often the case in clinical practice, parameters of agreement are preferred.

Humans↗
PubMed2004

Multiple stakeholder agreement on desired outcomes for adolescents' mental health services.

OBJECTIVES: This study identified desired outcomes for adolescent mental health services according to various stakeholders-adolescents, parents, and therapists-and examined agreement across these groups of stakeholders. Potential correlates of agreement, including the youth, family, and treatment characteristics, were also tested. METHODS: Interviews were conducted with 170 adolescents aged 11 to 18 years, their caregiver, and their psychotherapist when the adolescents entered community-based outpatient mental health services. Each participant reported up to three desired outcomes, which were coded into 30 outcome categories across five broad outcome domains. RESULTS: Although the most commonly reported desired outcome across all three stakeholder groups was to reduce anger and aggression, relatively poor agreement existed within the adolescent-parent-therapist triads on desired outcomes for individual youths. Almost two-thirds of the triads did not agree on even one of the desired outcomes for the adolescent's treatment, and most kappa statistics reflected poor agreement. Youths and therapists were each more likely than parents to report desired outcomes that were related to the family environment; youths were the least likely to report desired outcomes that were related to youth symptom reduction. Although many potential correlates of agreement were tested, only two variables were significantly associated with the likelihood that the individual triads would agree on treatment goals: youth anxiety disorder was associated with significantly greater agreement, whereas therapist cognitive-behavioral orientation was associated with significantly poorer agreement. CONCLUSIONS: Consistent with the research on adult mental health services, a lack of consensus was found among key stakeholders on desired outcome priorities for adolescent services. This lack of consensus may limit engagement in treatment and the effectiveness of care.

Adolescent↗
PubMed1989

Specialty choice in occupational therapy.

The shortage of occupational therapists specializing in mental health led to a survey of graduates from nine occupational therapy schools in the New York metropolitan area to determine the factors affecting their specialty choice. The variables examined were derived from a literature review of the specialty choice of psychiatry among medical students. They included personality, academic, clinical, and employment attributes. The results from 411 respondents supported the assumption that fewer occupational therapists were working in mental health than in pediatrics or physical disabilities. The primary factors affecting specialty choice were the fieldwork experience, the feelings of effectiveness in the specialty area, and the perception of employment availability. Recommendations based on a literature review and survey are included.

Adult↗
PubMed2001

Head and pelvic movements during a dynamic reaching task in sitting: implications for physical therapists.

OBJECTIVES: To describe the distance reached, speed, and movement of the head and pelvis of healthy volunteers; to describe any influence of age on these variables; and to compare healthy volunteers and subjects with hemiplegia while performing a seated reaching task. DESIGN: Age-matched, case-control study. SETTING: Gait laboratory in a general hospital. PARTICIPANTS: A convenience sample of 53 healthy volunteers (30 women; 23 men; mean age, 57yr; range, 30-79yr) and 5 subjects with hemiplegia (2 women, 3 men; mean age, 65yr; range, 60-78yr) were recruited within 6 weeks poststroke. INTERVENTIONS: Participants sat on a bench with feet supported and reached laterally as far as they could without falling. MAIN OUTCOME MEASURES: The speed, distance reached, and angular movements of the head and pelvis were recorded by using the 3-dimensional movement analysis system. RESULTS: A significant age-related reduction in the distance reached (p < .001), velocity of the movement (p =.000), and pelvic tilt used (p < .01) was found among healthy volunteers. Comparison of data from healthy volunteers and subjects with hemiplegia showed a significant reduction in the angular movements of the heads of subjects with hemiplegia. CONCLUSIONS: The findings suggest conservation of movement with increasing age and stroke. This movement reduction could have negative effects on a subject's ability to make postural changes in response to disturbance and activity. Such information may assist therapists to gain insight into the nature of balance deficits and the adaptive behavior that could result.

Adult↗
PubMed1995

Australian physiotherapists' and occupational therapists' views on professional practice.

The extent to which physiotherapists and occupational therapists endorse a humanistic, holistic approach to health care was addressed in a survey of attitudes of practicing occupational therapists (N = 378) and physiotherapists (N = 558). A 22-item questionnaire including aspects of therapist's knowledge and techniques, holistic approach, client characteristics, client/therapist relationship, and approaches to professional practice was employed. The findings indicate that the professional practices reflecting the new public health model prevailed. This model emphasizes client/therapist interaction, the client's own ability to change and improve, and holistic attitudes towards health care, along with the therapist's knowledge and skills. However, comparative analyses of the two therapy groups reveal that although both groups support a humanistic approach to client care, occupational therapists promote the client's resources and coping skills to a greater extent, place more emphasis on the client in terms of the client's capacity for recovery and coping abilities, were more involved with the social, personal, and psychological problems of the client, and place less emphasis on treatment methods and techniques than physiotherapists. Demographic variables including gender, age, and workplace setting (public/private) were found to be significantly related to views of professional practice. Recommendations for the training of therapists and the implications for practitioners are made and suggestions for further research are given.

Adult↗
PubMed1994

Leadership of mental health consultation groups: a model for group therapists.

Group therapists often lead consultation groups. For effective leadership it is important to distinguish between consultation groups and psychotherapy groups. A consultation group is one in which a leader serves as consultant to the members. Group process variables of task, contract, role of the leader, and effect of the larger system should be understood by the consultant. The process of defining, testing, and maintaining these variables encourages exploration of resistance and parallel process, and is an important aspect of the ongoing learning. Consultation group leaders should understand the importance of serving as group leader but not group therapist.

Group Processes↗
PubMed2003

When therapists do not want their clients to be homosexual: a response to Rosik's article.

This commentary is a response to Rosik's "Motivational, Ethical, and Epistemological Foundations in the Treatment of Unwanted Homoerotic Attraction" (this issue). Such treatment raises complex questions that cannot be resolved by focusing on the therapist's conservative versus liberal values. Most such clients are deeply ambivalent about their homosexual attractions. The degree to which their homosexuality is "unwanted" is highly variable among them and sometimes within them over time. Clients who are exclusively homosexual are very unlikely to be able to change their sexual attractions, whereas some clients who are bisexual may be more able to "manage" their homoerotic attractions (acting only on their heterosexual feelings). Marriage and family therapists should be able to support a client along whatever sexual orientation path the client ultimately takes, and the client's sense of integrity and interpersonal relatedness are the most important goals of all.

Attitude↗
PubMed1980

Success and failure in time-limited psychotherapy. A systematic comparison of two cases: comparison 1.

Why do some patients succeed in psychotherapy whereas others fail? Moreover, what can be learned from a comparison of two comparable patients treated by the same therapist under very similar conditions? Two cases drawn from the Vanderbilt Psychotherapy Project, a controlled study of process and outcome, were studied with a view toward deepening scientific and clinical understanding of time-limited psychoanalytic psychotherapy. Analyses of this kind are also important because the typical psychotherapy outcome study largely ignores individual cases entering into data of "average improvement." Based on systematic outcome and process measures, combined with a detailed study of complete process recordings, the case histories presented herein were those of two young men suffering from anxiety, depression, and social withdrawal who were treated by the same psychotherapist. The results of this analysis, the first of a series, suggest that therapy outcomes are importantly determined by the patient's ability to take advantage of the particular relationship the therapist has to offer; conversely, therapy fails if there is a poor match on these dimensions. Pertinent variables are further specified.

Adolescent↗
PubMed1985

Behavioral cohabitation: increasing satisfaction among nonmarried dyads?

The present study reports upon a standard behavior therapy treatment package applied to three clinically referred cohabitating couples. Multidimensional assessment measures included reports by self, partner, and external observers of couples' interactions. Moreover, a multiple-baseline design across couples was employed as a means of evaluating treatment efficacy. Therapy involved the weekly administration of bibliotherapy and exercise material, with therapist contact purposely minimized. An analysis of results indicates modest treatment success with considerable between-subject variability. These findings are discussed with regard to gender differences, ceiling effects, and utilization of standardized therapy packages. Recommendations are made for future behavioral cohabitation research.

Adult↗
PubMed1996

The relationship of cardiovascular and psychological impairments to the health status of patients enrolled in cardiac rehabilitation programs.

BACKGROUND AND PURPOSE: Understanding the causes of differences in disability among individuals is an important research focus for rehabilitation professionals. The purpose of this study was to examine the relationship between health status and the impairments commonly associated with cardiovascular pathophysiology. SUBJECTS: The subjects were patients (N=789) enrolled in 13 cardiac rehabilitation programs in Massachusetts. METHODS: Data were collected on psychological and physiological impairments, demographic characteristics, and health status. Multivariate analyses were used to determine which measures of impairment and patient characteristics were related to health status. RESULTS: Psychological impairment was related to all scales of the MOS 36-item Short-Form Health Survey (SF-36). Very few measures of physiological impairment and individual characteristics were related to SF-36 scores. The models accounted for 16% to 57% of the variability of the instrument's scales. CONCLUSION AND DISCUSSION: In patients entering cardiac rehabilitation, psychological distress is related to poor health in both the physical and psychological dimensions. Variability in health status is not well explained by traditional measures of impairment or demographic characteristics. Physical therapists working to address their patients' health needs must consider collecting data, setting goals, and devising interventions that address psychological impairment.

Adult↗